Determinants affecting adherence to antiretroviral therapy in patients receiving free treatment at the wellness clinic of the Bela Bela District Hospital, Limpopo Province

Abstract:

Purpose / Aim: To find out determinants affecting adherence to antiretroviral
therapy in patients receiving free treatment from the wellness clinic at Bela Bela
District Hospital in Limpopo province of South Africa.
Objectives: To identify the determinants which affect the adherence to ART
treatment among patients living with HIV and AIDS and to determine which of
these determinants are significant predictors of adherence among HIV and AIDS
patients.
Methodology: a descriptive retrospective, quantitative research.
Sampling: A population of 800 patients existing in the recording book was
retrieved from the patients’ records at the wellness clinic. Out of 800 a sample of
260 was derived using a simple size calculator tool.
Analysis: data were analysed by SPSS Windows Version 21.0. Descriptive
statistics means and frequencies were calculated. Chi-Square tests were done in
order to test the association between variables (such as age groups, gender,
weight groups, regimens and WHO stages). Logistic regression was run to
assess the effect of different determinants on the adherence to ART (e.g. viral
load affected the adherence contrary to age, gender and others).
Results: Female (65%) was more compliant to their male counterpart (35%).
Most of the patients (47.3%) in the study belonged to the age group 21 to 35
years and only (2.7%) in the age group less or equal to 20 years. Most patients
were categorised into WHO stage I (31.2%). Only 9.2% of the patients were
categorised into WHO Stage IV. Most of the patients in group 2 (41.3%) had a
weight between 40kgs and 54kgs and group 1 (4.2%) with patients whose weight
was less than 40kgs. One of the patients has no record on weight. The majority
of patients (44.2%) had CD4 count, less or equal to 100. Only 2.7% had CD4
count 300 and more. After 6 months of treatment, 37% of patients had CD4
count from 300 and above; 9.7% of the patients had CD4 countless than 200.
For 136 (52.3%) of the patients in the sample the information on CD4 count at 6
xi
months was missing. The majority of patients (72.7%) in the sample had low viral
load and only (27.3%) of the patients had high viral load.
Majority of patients (48.5%) were on New 1a Regimen instead of Regimen 1a
(30.8%) because of the side effects the latter has on them.
Some patients (11.2%) were on Regimen 1b, followed by patients (8.1%) on
Regimen New 1b. The remaining patients were on Regimen 1c, Reg 2 and
Truvada (1.6%).
Findings: The majority of patients were young females; in the age-group of 21-35
years. This is reproductive age with many challenges: earlier exposed to
infection, more vulnerable than males, stigmatisation, rape, fear of isolation.
Majority of patients were in the WHO stage 1 and 2. The WHO stage does not
depend on the level of CD4 count. It is important to consider the weight of the
patient before to initiate the treatment. More than the half patients had a CD4
count required to start with ART. After 6 months they were more adherent. Most
of them were on regimen Reg (New 1a) because of less side effects.
The findings showed also different types of associations with some variables
were significant determinants such as CD4 count had significant associations
with gender, viral load, regimen, WHO staging, the p-value was lesser than 0.05.
Conclusion: The results showed that viral load was the only determinant affecting
adherence in the current study. The number of males in this study population
was lower than females from the age group of less than 20 and age group of 21
to 35, and females than males in age group 36 to 50 and 51 or more. The lower
infectivity of males is linked to the state of denial and not testing for HIV. The
lower number in females can be due to their positive trends to the ART in their
old age. The reasons for the low number need to be investigated. Awareness
campaigns should be intentioned towards males. There should be publicity about
the equality of both male and female genders.